Multidisciplinary Management of Primary Sacral Tumors: A Tertiary Care Center’s Experience and Literature Review
Sacral tumors are rare and can be benign or malignant. Their management is multifactorial and is based on the pathology, extent, and local and distant spread. Managing sacral tumors is challenging due to their proximity to visceral and neural structures. Surgical wide excision has been the standard...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Spine Society
2022-08-01
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| Series: | Asian Spine Journal |
| Subjects: | |
| Online Access: | http://www.asianspinejournal.org/upload/pdf/asj-2021-0152.pdf |
| _version_ | 1798032307667337216 |
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| author | Venugopal Sarath Chander Ramachandran Govindasamy Venkata Ramakrishna Tukkapuram Swaroop Gopal Satish Rudrappa |
| author_facet | Venugopal Sarath Chander Ramachandran Govindasamy Venkata Ramakrishna Tukkapuram Swaroop Gopal Satish Rudrappa |
| author_sort | Venugopal Sarath Chander |
| collection | DOAJ |
| description | Sacral tumors are rare and can be benign or malignant. Their management is multifactorial and is based on the pathology, extent, and local and distant spread. Managing sacral tumors is challenging due to their proximity to visceral and neural structures. Surgical wide excision has been the standard of care for aggressive benign and malignant tumors. Our purpose was to evaluate the outcomes of a multimodal approach to managing primary sacral tumors in Sakra World Hospital, a tertiary spine care center in Bengaluru, India and perform a literature review to determine a workflow pathway. Our study was a retrospective review of patient records and included 15 patients with primary sacral tumors. Eleven surgically treated patients were evaluated clinically and radiologically and underwent biopsy before surgical excision by an all-posterior approach. A multidisciplinary approach that included intraoperative neural monitoring, plastic reconstruction, adjuvant chemotherapy, and radiotherapy was implemented whenever necessary. Sacral root preservation was attempted whenever feasible. Functional outcomes (based on the Visual Analog Scale [VAS] and Biagini scoring system) were analyzed along with disease control, with a minimum of 2 years of follow-up. The mean follow-up was 29±9.8 months. The mean VAS score significantly improved from 7.8±2.6 to 3.7±3.8 (p=0.026). Bowel function showed statistically significant improvement, from a mean score of 0.81±0.47 to 0.63±0.52 (p=0.026) at 2 years of follow-up. The mean pretreatment motor and bladder function scores were 0.53±0.31 and 0.74±0.44, respectively, improving to 0.48±0.33 and 0.68±0.56 at follow-up but without statistical significance. There was no significant loss of function, which is expected in radical sacral resections. In conclusion, primary sacral tumors require a multidisciplinary approach and management for optimal outcomes. A stand-alone posterior approach can be employed to treat most sacral lesions. En-bloc wide resection is the optimal treatment for primary malignant and aggressive benign tumors. Preservation of at least one functional S2 nerve root is imperative to preserve bowel and bladder function. |
| first_indexed | 2024-04-11T20:10:40Z |
| format | Article |
| id | doaj.art-a7cbb76499e1407dae01c515a4069860 |
| institution | Directory Open Access Journal |
| issn | 1976-1902 1976-7846 |
| language | English |
| last_indexed | 2024-04-11T20:10:40Z |
| publishDate | 2022-08-01 |
| publisher | Korean Spine Society |
| record_format | Article |
| series | Asian Spine Journal |
| spelling | doaj.art-a7cbb76499e1407dae01c515a40698602022-12-22T04:05:06ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462022-08-0116456758210.31616/asj.2021.01521390Multidisciplinary Management of Primary Sacral Tumors: A Tertiary Care Center’s Experience and Literature ReviewVenugopal Sarath Chander0Ramachandran Govindasamy1Venkata Ramakrishna Tukkapuram2Swaroop Gopal3Satish Rudrappa4 Institute of Neurosciences, Sakra World Hospital, Bangalore, India Institute of Neurosciences, Sakra World Hospital, Bangalore, India Institute of Neurosciences, Sakra World Hospital, Bangalore, India Institute of Neurosciences, Sakra World Hospital, Bangalore, India Institute of Neurosciences, Sakra World Hospital, Bangalore, IndiaSacral tumors are rare and can be benign or malignant. Their management is multifactorial and is based on the pathology, extent, and local and distant spread. Managing sacral tumors is challenging due to their proximity to visceral and neural structures. Surgical wide excision has been the standard of care for aggressive benign and malignant tumors. Our purpose was to evaluate the outcomes of a multimodal approach to managing primary sacral tumors in Sakra World Hospital, a tertiary spine care center in Bengaluru, India and perform a literature review to determine a workflow pathway. Our study was a retrospective review of patient records and included 15 patients with primary sacral tumors. Eleven surgically treated patients were evaluated clinically and radiologically and underwent biopsy before surgical excision by an all-posterior approach. A multidisciplinary approach that included intraoperative neural monitoring, plastic reconstruction, adjuvant chemotherapy, and radiotherapy was implemented whenever necessary. Sacral root preservation was attempted whenever feasible. Functional outcomes (based on the Visual Analog Scale [VAS] and Biagini scoring system) were analyzed along with disease control, with a minimum of 2 years of follow-up. The mean follow-up was 29±9.8 months. The mean VAS score significantly improved from 7.8±2.6 to 3.7±3.8 (p=0.026). Bowel function showed statistically significant improvement, from a mean score of 0.81±0.47 to 0.63±0.52 (p=0.026) at 2 years of follow-up. The mean pretreatment motor and bladder function scores were 0.53±0.31 and 0.74±0.44, respectively, improving to 0.48±0.33 and 0.68±0.56 at follow-up but without statistical significance. There was no significant loss of function, which is expected in radical sacral resections. In conclusion, primary sacral tumors require a multidisciplinary approach and management for optimal outcomes. A stand-alone posterior approach can be employed to treat most sacral lesions. En-bloc wide resection is the optimal treatment for primary malignant and aggressive benign tumors. Preservation of at least one functional S2 nerve root is imperative to preserve bowel and bladder function.http://www.asianspinejournal.org/upload/pdf/asj-2021-0152.pdfsacral tumorssacrectomyposterior approachliterature review |
| spellingShingle | Venugopal Sarath Chander Ramachandran Govindasamy Venkata Ramakrishna Tukkapuram Swaroop Gopal Satish Rudrappa Multidisciplinary Management of Primary Sacral Tumors: A Tertiary Care Center’s Experience and Literature Review Asian Spine Journal sacral tumors sacrectomy posterior approach literature review |
| title | Multidisciplinary Management of Primary Sacral Tumors: A Tertiary Care Center’s Experience and Literature Review |
| title_full | Multidisciplinary Management of Primary Sacral Tumors: A Tertiary Care Center’s Experience and Literature Review |
| title_fullStr | Multidisciplinary Management of Primary Sacral Tumors: A Tertiary Care Center’s Experience and Literature Review |
| title_full_unstemmed | Multidisciplinary Management of Primary Sacral Tumors: A Tertiary Care Center’s Experience and Literature Review |
| title_short | Multidisciplinary Management of Primary Sacral Tumors: A Tertiary Care Center’s Experience and Literature Review |
| title_sort | multidisciplinary management of primary sacral tumors a tertiary care center s experience and literature review |
| topic | sacral tumors sacrectomy posterior approach literature review |
| url | http://www.asianspinejournal.org/upload/pdf/asj-2021-0152.pdf |
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